Aggression in Memory Care facility

Catawba Girl

Hello everyone.  We transitioned my dad to a memory care facility earlier this week and he’s having a terrible time transitioning.  He’s refusing to take his medications and now he’s become violent.  The facility had him taken to the hospital during the night.  What are our options?  What happens next?  Thanks everyone.

MN Chickadee

I'm sorry you and your dad are in this position. Is the facility a true memory care facility, with staff trained in dementia and a higher staffing ratio than assisted living? This is imperative, so if this is not the case it might not be the right place for him. Staff trained in dementia will have better skills at coaxing a person into taking meds, bathing etc. Many of our PWDs would become combative if we came at them without proper communication techniques and the right approach.


Make sure the hospital tests him for a UTI with a culture, this can cause outbursts and all kinds of behavior. I assume they will do a work up of urine and blood in case there is some underlying issue causing this. Sometimes a PWD can't communicate they are in discomfort, and sometimes medical problems can manifest as behavior. 

If none of this is causing it, I would have him transferred from the hospital to a geriatric psychiatric unit for inpatient treatment. A regular psych unit will NOT do, they do not have the skill set for dementia. A Geriatric unit is specifically designed to treat behaviors associated with dementia. Most people stay at least a few weeks, and the nurses and geri-psychiatrist work on getting meds figured out to get the person stable. They find medications that work for the individual so they can be cared for, not be combative, and have a higher quality of life. From there he could be transferred back to his facility or a new one. In my area the nearest geriatric psych unit is a few hours a way, but worth it. If someone is violent this is the setting you need to find no matter how much trouble or distance it is. You will likely want to have a geriatric psychiatrist on his care team, someone you can work with to tweak meds in the future if something changes in hopes of avoiding another trip to in-patient. Good luck and let us know how it goes so we can learn from your experience. Hang in there. 

M1

Agree completely with MN Chickadee, that’s what needs to happen. Good luck-keep us posted when you can.

LicketyGlitz

I second Chickadee! Once he's stable on his meds it should be easier for him, not easy... but easier. As far as him refusing meds in MC, they've either got to get creative about getting them in him or you may have to take this on. If there is a crush order for the medication from his doctors then they can put his meds in his favorite food.

The MC we had my mom in had the same 3-refusals=no meds rule (actually I think it might be federal law for elderly protection), and they were absymal at taking the time to crush and give them to her, so I took on her twice a day med dispensing, but I lived close enough to do so.

Good luck!

Salsam

I think it is horrible they just took him to the hospital.  What are the procedures?  In my case, they called me first, and I stayed with him for 8 1/2 hours.  I was traumatized, but you can read my post titled "Violence or Fear?"  
My dad would have gone absolutely NUTS in the hospital and then they really would have drugged him up more. 

I did consent to letting the hospice people work with him and adjust his meds. 

The biggest problem is many of them DO NOT WANT TO BE THERE.  They have no choice and no voice...and none of us want that.  

Luckily in my case, the MC coordinator is working with him.  I don't think they want to lose the business.  

I have contacted other people--today a friend who works in the field of evaluating nursing homes.   She confirmed what I thought...in my area there are only 2 other options. 

I don't think there is a geriatric psychiatrist close by...but I know my dad's history, and you know your dad's history.  

I realized my dad HATES birthdays...especially now that he is older.  He loved the cake, but any mention of birthday...he threw the present on the floor. 

It scared him...He is also grieving the loss of my mom...he has screamed, "Her brain has gone all to hell!" 
The other thing he says loudly is "Who PUT me here?   About 80% of the people are crippled or mentally disabled!"   The issue is he does not see himself as one of them...which of us does want to see ourselves as others see us, regardless of our dimentia status, unless it is our best side!

Today I did not go visit, but luckily I have the Hospice care woman who bathes him and is not connected with the facility to tell me he was doing fine today, so I think the new sets of medications are helping. 

I will go tomorrow.  

I took both my mom and my dad out to eat on Saturday...and they were both content.  There is no guarantee they remember going out...but that doesn't mean they didn't enjoy when they went out.  And on Sunday my mom thought I had died, and she was crying.  Today that was not her issue, because my brother talked to her by phone and it was a different loop. 

On Sunday my dad apparently fell while I was walking with my mom...and the head med tech was not happy...apparently she blamed the caregivers.  I did not see it but the cut on his forehead warranted calling Hospice and technically they could have sent him to the hospital for that but since I was there I said, "No.  I ONLY want him going to the hospital for a broken bone, a heart attack, or a stroke. "  Something serious.  Unless he truly HURT another resident they should give you other options.  

I did get a second call one night about my dad that he had hit one of the caregivers, and they were letting me know, and he spit out his meds.  I asked them what they did, and they said they cleared the hallway of residents and he was pacing.  I asked them to Facetime with me, but their IPad was out of charge and when I called back the Memory Care Coordinator had gone up there and redirected him and got him to take his meds. 

This showed me that they are trying hard to work with him.  I have talked with her at length. 

She is calm and patient and understanding.  She has worked her way up as opposed to the other nurse that called me frantically at 2 AM and had lots of credentials but no experience working on the floor with residents. 

The UTI is a real possibility, too.  That is how my dad's erratic behavior at home started, and we were overwhelmed and Hospice diagnosed over the phone.  If your dad qualifies for Hospice (and mine did under an Alzheimer's diagnosis) they are very very helpful.  Dimentia is different in every person.  The brain falls apart differently in each person, and they each have different personalities to begin with. 

Keep us posted. I am in the same position, except my dad seemed to be doing fine and then after 3 months was extremely depressed and acting out, pushing his walker into things.   I find right now it takes up about 80% of my brain thinking about what to do and this site helps a lot.  And I do other things and remind myself it is one day at a time.